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When psychosocial supports go, mental health needs increase

17 Mar 2017

The management of mental health within the AMA Secretariat now resides within both Public Health and Medical Practice. This mirrors the realities facing most people experiencing mental health problems – that mental illness often requires a combination of clinical treatment and psychosocial supports. It’s also a recognition that social determinants of health impact on mental and physical wellbeing.

At a recent meeting of mental health experts organised as part of the ALP’s Health Summit, a recurring theme was the paucity and inconsistency of services that fit between the GP and the ED. This presents myriad challenges to mental health reform, an agenda that Minister Hunt has signalled as a priority.

The way Primary Health Networks (PHNs) will commission mental health services is critical to the reform process. Concerns have been expressed about PHNs not being able to purchase psychosocial services. These are services that coordinate supports, such as employment and housing, for people with severe and persistent mental health issues who have complex needs. As mental health funding is transferring to the PHNs, it is reasonable to expect that, at a minimum, PHNs provide both clinical and psychosocial care, as needed.

Further complicating the mental health landscape is the operation of the National Disability Insurance Scheme (NDIS). Three important mental health programs – Partners in Recovery (PIR), Day to Day Living (D2DL) and Personal Helpers and Mentors (PhaMs) – are being rolled into the NDIS. The concern here is that those people assessed as ineligible for the NDIS will now not be eligible for other forms of mental health care. This could see greater pressure on GPs, psychiatrists and hospitals from those who fall ‘between the new cracks’ and are left with few alternative options for help.

There is a strong argument that investment in community mental health services is needed; providing GPs with enhanced referral pathways, and service options, especially for those with low to moderate mental health problems or who need supports in managing their day-to-day activities. How many Australians with mental health conditions will now no longer be eligible for the NDIS if no evaluation is undertaken?

A widely held concern is that the NDIS may end up excluding people with mental health problems. Where these people go, who will treat them, where they will be treated, and what medical and psychosocial supports will be provided remain in the ‘unknown’ ledger. What can be predicted is that those with mental illness who are excluded from the NDIS may end up taking up time and energy of clinicians and other health providers in more costly health care.

The Productivity Commission has released an Issues Paper on the costs of the NDIS. The Commission is looking at the sustainability, costs and future cost pressures of the NDIS, and how it impacts on, and operates with, mainstream services. The current projection is that by 2019-20, there will be 460,000 participants at a cost of $22 billion per annum.

According to the Commission, “poorly defined boundaries between the NDIS and mainstream services can raise the risk of gaps in services, duplication of services and cost shifting … particular concerns have been raised about the interface between the NDIS and mental health services.”

Another challenge is workforce, and workforce distribution. The Productivity Commission identified the difficulties in recruiting qualified staff, the unequal workforce distribution and demand for carers as key issues. It’s worth noting that at the March 2017 Senate Estimates hearing, the Department of Health said that, in relation to on-going funding to the Mental Health Nurse Incentive Program (MHNIP), it is “the whole picture” of a region that DoH looks at. Said one official: “If you look at, for example eastern Melbourne, it is very significant. There is a congregation of psychiatry and psychology services in that region.”

The worry here is pressure points in mental health care will increase and worsen. Waiting times and bottlenecks are created because the supports for people with low to moderate mental health conditions, or people needing support in their day to day living, are no longer being provided for. This will directly increase the burden on psychiatry and public hospitals to meet a growing and unnecessary demand for care.

With the 5th National Mental Health Plan currently being drafted, and a number of inquiries and reviews of the NDIS underway, there is no doubt the Government is on the path towards substantial mental health reform. What is not yet clear yet is how these reviews will ensure that people experiencing mental health problems are able to access an integrated system that meets their needs.